Intervention Review

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Antiviral interventions for liver transplant patients with recurrent graft infection due to hepatitis C virus

  1. Kurinchi Selvan Gurusamy1,*,
  2. Emmanuel Tsochatzis2,
  3. Clare D Toon3,
  4. Elias Xirouchakis4,
  5. Andrew K Burroughs5,
  6. Brian R Davidson1

Editorial Group: Cochrane Hepato-Biliary Group

Published Online: 4 DEC 2013

Assessed as up-to-date: 14 FEB 2013

DOI: 10.1002/14651858.CD006803.pub4


How to Cite

Gurusamy KS, Tsochatzis E, Toon CD, Xirouchakis E, Burroughs AK, Davidson BR. Antiviral interventions for liver transplant patients with recurrent graft infection due to hepatitis C virus. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD006803. DOI: 10.1002/14651858.CD006803.pub4.

Author Information

  1. 1

    Royal Free Campus, UCL Medical School, Department of Surgery, London, UK

  2. 2

    Royal Free Hampstead NHS Foundation Trust and UCL Institute of Liver and Digestive Health, Sheila Sherlock Liver Centre, London, UK

  3. 3

    University College London, Division of Surgery & Interventional Science, London, London, UK

  4. 4

    Athens Medical Group, Hospital P. Faliro, GI and Hepatology, Athens, Greece

  5. 5

    Royal Free Hampstead NHS Foundation Trust, Sheila Sherlock Liver Centre, London, UK

*Kurinchi Selvan Gurusamy, Department of Surgery, Royal Free Campus, UCL Medical School, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK. k.gurusamy@ucl.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 4 DEC 2013

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[Figure 1]
Figure 1. Study flow diagram.
[Figure 2]
Figure 2. Methodological quality graph: Review authors' judgements about each methodological quality item presented as percentages across all included studies.
[Figure 3]
Figure 3. Methodological quality summary: Review authors' judgements about each methodological quality item for each included study.
[Figure 4]
Figure 4. Trial Sequential Analysis of mortality (ribavirin plus peg interferon versus peg interferon)The diversity-adjusted required information size (DARIS) was calculated to 16,594 patients, based on the proportion of patients in the control group with the outcome of 4.1%, a relative risk reduction of 20%, an alpha of 5%, a beta of 20%, and a diversity of 0%. To account for zero event groups, a continuity correction of 0.01 was used in the calculation of the cumulative Z-curve (blue line). After accruing 98 participants in two trials, only 0.59% of the DARIS has been reached. Accordingly, the Trial Sequential Analysis does not show the required information size and the trial sequential monitoring boundaries. As shown, the conventional boundaries (dotted red line) have also not been crossed by the cumulative Z-curve.
[Figure 5]
Figure 5. Trial Sequential Analysis of fibrosis worsening (ribavirin plus peg interferon versus control)The diversity-adjusted required information size (DARIS) was calculated to 4066 patients, based on the proportion of patients in the control group with the outcome of 65.1%, a relative risk reduction of 20%, an alpha of 5%, a beta of 20%, and a diversity of 88.93%. After accruing 126 participants in two trials, only 3.1% of the DARIS has been reached. Accordingly, the Trial Sequential Analysis does not show the required information size and the trial sequential monitoring boundaries. As shown, the conventional boundaries (dotted red line) was no longer crossed by the cumulative Z-curve after two trials although the conventional boundaries were crossed after the first trial.
[Analysis 1.1]
Analysis 1.1. Comparison 1 Intervention versus control, Outcome 1 Mortality.
[Analysis 1.2]
Analysis 1.2. Comparison 1 Intervention versus control, Outcome 2 Retransplantation after start of therapy.
[Analysis 1.3]
Analysis 1.3. Comparison 1 Intervention versus control, Outcome 3 Treatment-related serious adverse events (proportion).
[Analysis 1.4]
Analysis 1.4. Comparison 1 Intervention versus control, Outcome 4 Treatment-related serious adverse events (number of serious adverse events).
[Analysis 1.5]
Analysis 1.5. Comparison 1 Intervention versus control, Outcome 5 Graft rejection requiring retransplantation after start of therapy.
[Analysis 1.6]
Analysis 1.6. Comparison 1 Intervention versus control, Outcome 6 Graft rejection requiring medical treatment.
[Analysis 1.7]
Analysis 1.7. Comparison 1 Intervention versus control, Outcome 7 Graft rejection (others with unknown treatment).
[Analysis 1.8]
Analysis 1.8. Comparison 1 Intervention versus control, Outcome 8 Fibrosis worsening.